In 2007, during a two-day imbizo in the Eastern Cape, then president Thabo Mbeki told residents of Ugie and surrounds in the Joe Gqabi District “to not wait for the government to help them but start initiatives that will draw the government’s attention”.

Now, 16 years and three presidents later, the residents of Ugie still have to make do with a four-roomed residential house repurposed as a clinic. And in a rural village near Sterkspruit, in the same district, residents desperate for healthcare services took it upon themselves in 1998 to convert part of an abandoned school building into a health facility they called Macacuma Clinic (sometimes called Macacume Clinic).

But this year, Ugie residents, at least, received some good news.

During her budget speech in March, Eastern Cape health MEC Nomakhosazana Meth acknowledged that the maintenance of facilities is an important aspect of ensuring that her department is ready for the full implementation of the proposed National Health Insurance system.

Meth said the provincial health department’s focus will be on the maintenance and upgrading of buildings in the 2023/24 financial year and over the medium-term expenditure framework (MTEF). The department had allocated a budget of more than R4-billion for this and the Joe Gqabi District had received more than R1-million of this for maintenance. See the full list of planned infrastructure projects here.

An entrance to the Ugie Clinic in the Eastern Cape. (Photo: Black Star / Spotlight)

Ugie Clinic will be one of five facilities to be renovated and upgraded in the Elundini subdistrict in Joe Gqabi over the 2023/24 MTEF (which covers three financial years). The Macacuma Clinic in the Senqu subdistrict, however, is not included in these plans.

Member of the provincial legislature for the United Democratic Movement Nkosinathi Ndlodaka tells Spotlight he doesn’t understand why it took so long.

If they are struggling to fix a toilet, how do you think they will be able to build a clinic?

“Thabo Mbeki spoke on behalf of the government when he promised a clinic to the people of Ugie. It was not going to be built with his own money. Considering that the current administration is still in power, I don’t know why it has taken 17 years for them to realise that a promise was made,” he says.

Ndlodaka called on the department to “avoid wasting money on temporary solutions”, adding that they need new toilets at the clinic. “And the department’s failure to have a proper waste storage facility at Ugie Clinic could have legal implications and that must be attended to as a matter of urgency.” 

Making do despite challenges

For now, people in Ugie who depend on public healthcare still have to make do with the four-roomed clinic. During Spotlight’s visit, the waiting area was shared by patients and a data capturer. The manager’s office doubles as a consultation room and a storage area for patient files.

“Not only does our facility create inconveniences, it also inconveniences patients, since the two rooms we used for consultations are about 5m wide and no privacy is available. Any person inside the building can easily listen to patients being consulted,” a nurse tells Spotlight. She asked not to be named for fear of repercussions from the provincial health department.

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“I have been told that then president Thabo Mbeki, during his visit to Aliwal North and Ugie in 2007 as part of the Presidential Imbizo programme, suggested that a new community health centre needed to be built, but that never happened,” she says.

“Despite another promise in 2022 that our clinic will be constructed in February 2023 – they even cleared an open space next to our clinic – nothing has happened. It is not a surprise to us that February came and went without our clinic being built,” the nurse says.

Some communities in Sterkspruit have to travel long distances to access healthcare services. (Photo: Black Star / Spotlight)

She also says while they understand that building a clinic is a big project, it would help if the department at least fixed the toilets. “If they are struggling to fix a toilet, how do you think they will be able to build a clinic?” She says they only have one toilet that staff share with both male and female patients.

Poor infrastructure and staff shortages

In Macacuma village near Sterkspruit, following a merger between Egugwini Junior Primary School and Macacume Senior Primary School, the old school building was left abandoned, and residents felt that leaving it to rot was a waste of taxpayers’ money. They repurposed part of the school into a satellite clinic around 1998 but have since been battling chronic staff shortages and infrastructure challenges.

The school has two block buildings with three classrooms used for the clinic. The other rooms are used by residents as a victim empowerment centre, a community centre and an old age centre.

The state of the Macacuma Clinic came under the spotlight when the provincial legislature’s health committee visited several public health facilities in the Joe Gqabi District from 10 to 14 October 2022, including Ugie Clinic. Its findings, observations and recommendations were captured in a report. In February, as part of the “Taking the Legislature to the People” programme, the committee presented its findings to the community.

Committee chairperson Nozibele Nyalambisa painted a bleak picture of poor infrastructure and staff shortages.

The report noted, among other things, that the infrastructure at most of the clinics and hospitals in the district was dilapidated and “poses a health hazard to both staff and patients”, which in turn would lead to litigation.

When there is no water, we must fetch water in buckets to use at the clinic and patients are expected to bring their own water.

Clinics still had space challenges, unreliable water supply and dilapidated structures, and many did not have proper fencing. There was also the “serious challenge of stipends” which were not paid to clinic committees and hospital board members. This was “unacceptable and tantamount to unfair labour practice”. 

The Ugie Clinic waiting area is shared by patients and a data capturer. (Photo: Black Star / Spotlight)

According to the report, the department had a tendency to defer replacement when an official had resigned, died or retired, while posts were funded. Out of 21 clinics in the subdistrict only seven had permanent operational managers, and at some clinics there were no visiting doctors and at nine the contracts with pharmacy assistants ended in March 2023, which meant there would be no one to dispense medicines.

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At Ugie Clinic, the report states, space constraints also meant that “medical waste is kept next to the toilet due to unavailability of a storeroom”.

Spotlight asked Nyalambisa what steps are being taken by the committee to make sure its recommendations are implemented, but we have not received a response after several follow-ups. 

Spotlight also asked the provincial health department how decisions around the upgrading of clinics are made and how it intends to address the staffing issues. No response has been forthcoming despite asking several times. 

A community’s hopes

Meanwhile, Nerman Gaga (71) of the Macacuma Clinic Committee says their village has not had a proper healthcare facility since people settled there in the early 1900s.

“Our hopes are pinned on the recent visit by government officials [the health committee members] to take the challenges of the facility to the department to reach a lasting solution. At our last meeting with the subdistrict management we were informed that the school did not meet the standards for it to be used as a clinic, so the department cannot refurbish it. Besides the fact that we do not have a proper building, we also lack running water and we only harvest rainwater. When there is no water, we must fetch water in buckets to use at the clinic and patients are expected to bring their own water,” Gaga says.

Patients wait outside an abandoned school building that has been repurposed as a satellite clinic by Sterkspruit residents. (Photo: Black Star / Spotlight)

“The residents of Macacuma used to [before repurposing the school] attend Zanethemba Clinic in Thaba-Lesoba Village, but they were having difficulties getting to Zanethemba due to lack of transport,” says a facility worker who asked not to be named. “To reach the nearest hospital, Mpilisweni Hospital, the sick had to travel over 20km. To alleviate this situation, villagers and the department renovated an abandoned Egugwini school building and turned it into a clinic. The clinic began as a satellite clinic of Zanethemba Clinic and all the staff were borrowed from different facilities in the district.”

The worker says there is now only one professional nurse and an assistant nurse who were employed when the clinic became a full-service clinic in about 2013. There are four community health workers and two home-based care workers. “That single nurse is under massive strain, as she has to treat [about] 1,500 patients per month. To add insult to injury, the only assistant pharmacist was taken away in March to another facility that is bigger than ours. In addition to the nurse being a manager, she is now also a pharmacist at the same time,” the worker says.

Patients queue at the Macacuma Clinic. (Photo: Black Star / Spotlight)

According to another healthcare worker at the clinic, patients feel the impact of staff shortages. “When this single nurse is on leave, the department borrows another nurse from another facility so that the patients can receive medical care. When we contacted the department about the staff shortage we were told there is no budget for new staff and that the Macacuma matter would be addressed after the building issue had been resolved. Having no budget and no general assistants, we have resorted to cleaning the facility on our own while using our own cleaning materials, since the department does not provide us with any.”

The worker says there are three villages in Senqu Local Municipality served by the clinic and calling an ambulance “is of no use since it takes hours to arrive or never arrives at all”. 

The old school building that houses the Macacuma Clinic is also used as a victim empowerment centre, a community centre and an old age centre. (Photo: Black Star / Spotlight)

Nerman Gaga, of the Macacuma Clinic Committee, says their village has not had a health facility since people settled there in the early 1900s. (Photo: Black Star / Spotlight)

“These three converted classrooms are in a state of disarray, which makes our facility unusable. Our patients are mainly the elderly, who have difficulty accessing these classrooms, but since we don’t have another alternative, we use them.”  

Notwithstanding these challenges, villagers say the clinic has become an integral part of their lives since it is easily accessible.

 “The clinic is our hope,” Thandiswa Msala (35) tells Spotlight, “since residents used to spend R80 travelling to the nearby Zanethemba Clinic, and it was always full since it served more than four villages.”

“My grandfather used to go to Zanethemba Clinic early in the morning and sometimes he would return without his chronic medication. It was far away for those who could not afford bus fare, and along the way there was an open space where criminals may target them,” Msala adds.

One Macacuma Clinic user, Winky Mguye, says that “despite the clinic’s small size, it is well managed and clean and the queue moves quickly. Approximately two hours are spent waiting between arrival and departure at various points. The only challenge we face is space, since we cannot wait inside due to insufficient space.” DM

This article was produced by Spotlight – in-depth, public interest health journalism.